Analysis

Stillbirth should be given greater priority on the global health agenda

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4620 (Published 23 September 2015) Cite this as: BMJ 2015;351:h4620
  1. Zeshan U Qureshi, academic clinical fellow in international child health1,
  2. Joseph Millum, bioethicist2,
  3. Hannah Blencowe, lecturer in infectious disease epidemiology3,
  4. Maureen Kelley, associate professor in bioethics4,
  5. Edward Fottrell, lecturer in epidemiology and global health metrics1,
  6. Joy E Lawn, professor in maternal, reproductive, and child health epidemiology3,
  7. Anthony Costello, professor in international child health1,
  8. Tim Colbourn, lecturer in global health epidemiology and evaluation1
  1. 1Institute for Global Health, University College London, London, UK
  2. 2Clinical Center Department of Bioethics/Fogarty International Center, National Institutes of Health, Bethesda, USA
  3. 3Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Ethox Centre, Nuffield Department of Population Health, Oxford University, Oxford, UK
  1. Correspondence to: Z Qureshi zeshan.u.qureshi{at}gmail.com
  • Accepted 22 July 2015

Stillbirths are largely excluded from international measures of mortality and morbidity. Zeshan Qureshi and colleagues argue that stillbirth should be higher on the global health agenda.

The global rate of stillbirths was estimated to be 18.9 per 1000 births in 2009, equating to a total of 2.64 million stillbirths, 1.2 million of which were during labour.1 2 3 The burden is heaviest for women in low and middle income countries and the poorest women in high income countries.2 Given its scale, stillbirth prevention should be high on the global health agenda. However, in the current draft of the United Nations sustainable development goals, which sets global targets for 2015-30, stillbirth is not mentioned, even though neonatal and under 5 mortality rates are included.4

Explicit targets and accountability to track and reduce national stillbirth rates would help raise the political profile of stillbirths, engaging global leaders and increasing country government programmatic action. The Every Newborn action plan, which aims to provide all nations with a platform for ending preventable newborn deaths and stillbirths, proposed a target of reducing the stillbirth rate to ≤12 per 1000 births in every country by 2030.3 There is a strong case to be made at country and international levels that the introduction of stillbirth targets will encourage greater investment in perinatal care interventions. This has the potential to reduce neonatal and maternal deaths, as well as stillbirths, giving a triple return on programme investment and research.5

In this article we argue for international adoption of the Every Newborn action plan stillbirth targets.

Definition

To facilitate international comparisons and improve measurement, the World Health Organization recommends a definition of stillbirth as late fetal loss with a birth weight of ≥1000 g or length ≥35 cm, or after 28 weeks. Many high income countries …

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